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AN 


INQUIRY  #&  &»***,& 


INTO  THE 


USE  OF  THE  OMENTUM. 


BY  JAMES  RUSH. 


OF  PHILADELPHIA. 


PHILADELPHIA, 

FROM  THE  PRESS  OF  T.  fcs*  G.-PALMER. 


/ 


1809. 


T 


> 


*• 


V * 


V4 


AN 


INAUGURAL  DISSERTATION 

FOR 

The  Degree  of  Doctor  of  Medicine . 


SUBMITTED  TO 

) 

THE  EXAMINATION  OF  THE 


REV.  JOHN  M‘DOWEL,  LL.  D.  PROVOST, 


THE 


TRUSTEES  AND  MEDICAL  PROFESSORS 


OF  THE 


University  of  Pennsylvania. 

ON  THE  19TH  DAY  OF  APRIL,  1809 


* 


. 


TO  BENJAMIN  RUSH,  M.  D 


PROFESSOR  OF  THE  INSTITUTES  AND  PRACTICE  OF  MEDI- 
CINE, AND  OF  CLINICAL  PRACTICE,  IN  THE  UNIVERSITY 
OF  PENNSYLVANIA. 


HONOURED  SIR, 

For  favours  which  I can  neither  express  nor 
repay,  I beg  your  acceptance,  in  this  public  manner,  of 
the  acknowledgments  of  your  affectionate  and  grateful 
son  and  pupil, 


JAMES  RUSH, 


• ♦ 

, * i . fr  - , i ' c.  , u; 


* 


P ' 


*:*  :r  ■*** 


i . . r:i  , i : n • ' ;•  - : ' o' l 

i 

i ’■  • ?1  ’ Y? 

••  ‘ 


V 


ALSO  TO 


CASPAR  WISTAR,  M.  D. 

PROFESSOR  OF  ANATOMY ; 

JAMES  WOODHOUSE,  M.  D. 

PROFESSOR  OF  CHEMISTRY ; 

BENJAMIN  SMITH  BARTON,  M.  D. 

PROFESSOR  OF  MATERIA  MEDICA,  NATURAL  HISTORY,  AND  BOTANY , 
AND  TO 

PHILIP  SYNG  PHYSICK,  M.  D. 

AND 

JOHN  SYNG  DORSEY,  M.  D. 

UNITED  PROFESSORS  OF  SURGERY, 

IN  THE  UNIVERSITY  OF  PENNSYLVANIA, 

AS  A TESTIMONY  OF  GRATITUDE 
FOR  THEIR  CIVILITIES,  AND  THE  INSTRUCTION  DERIVED  FROM 
THEIR  LECTURES, 

THE  FOLLOWING  DISSERTATION 

IS  INSCRIBED, 

BY  THEIR  OBLIGED  FRIEND  AND  PUPIL, 


JAMES  RUSH. 


• - 


- 

' * * 


■rr 

, . . V - 

i 


AN  INQUIRY 


INTO  THE 

USE  OF  THE  OMENTUM. 


N O VEL  opinions  in  science,  like  the  essays  of  infant 
speech,  are  often  faultering  or  false.  Let  it  be  considered, 
however,  that  the  faulter  may  become  the  tone  of  authori- 
ty, and  that  error  detected  lessens  the  embarrassments  of 
truth.  These  reflections  countenance  the  attempts  of 
theory,  and  encourage  the  adventurer  with  hope.  It  is 
true,  the  period  has  been  anticipated  when  observation 
and  books  should  have  yielded  their  contribution  to  the 
writer ; but  the  subject  has  been  entered  upon,  from  a 
conviction  that  system  in  arrangement  and  method  in 
reasoning,  give  their  advantages  to  the  framer.  He  who 
benefits  an  individual  does  a plausible  duty,  and  such 
is  his  beneficence,  who  renders  a service  to  himself. 
Truth  lies  hidden  beneath  the  surface,  and  though 
theory  cannot  always  make  the  discovery,  it  may  work 
upon  the  spot  of  its  concealment : a better  occupation 
surely  than  his,  who  indolently  waits,  vainly  imagining 
it  will  take  root,  and  spring  up  under  his  feet. 

B 


10 


The  theories  or  reasonings  in  physiology,  and  their 
importance  to  practice,  have  been  particularly  the  ob- 
jects of  cavil.  Many  of  the  functions  of  the  human 
body  can  be  explained  only  by  analogy ; as  if  nature, 
for  the  comprehension  of  her  noblest  work,  required 
the  exertion  of  man’s  noblest  faculty.  The  enemies  of 
physiology  object  not  to  its  established,  but  to  its  un- 
known doctrines.  The  practical  utility  of  those  alrea- 
dy proved,  are  too  obvious  to  admit  of  dispute.  The 
circulation  of  the  blood,  the  process  of  digestion,  and 
the  actions  of  the  intestines,  are  truths,  without  the 
knowledge  of  which  even  the  empiric  could  scarcely 
practise.  These  were  the  result  of  physiological  re- 
searches ; and  were  once  as  obscure  as  many  things  yet 
to  be  discovered.  This  is  my  apology  for  considering 
a speculative  subject  in  physiology. 

In  the  list  of  subjects  for  discussion,  an  inquiry  into 
the  use  of  the  omentum  in  the  animal  structure,  has  been 
suggested  by  the  doctrine  of  the  office  of  sanguification, 
lately,  ascribed  to  the  liver,  by  my  father*.  To  this 
function,  he  has  also  attributed  the  conversion  of  fat 
into  the  matter  of  nourishment  for  the  body.  This 
opinion  I have  embraced,  and  by  its  more  particular 
application  to  explain  the  intention  of  the  omentum, 
shall  endeavour  to  treat  it  with  more  minuteness  than 
the  author  himself  has  devoted  to  it  in  his  lectures. 

'*  See  Medical  Museum,  Yol.  Ill — Dr.  Rush  on  the  functions  of 
the  liver,  spleen,  See. 


il 

It  would  be  tedious  to  consider,  at  length,  the  struc- 
ture and  other  anatomical  circumstances  of  the  omen- 
tum. It  will  be  sufficient  to  observe,  that  it  is  a pen- 
dulous membranous  body,  folded  so  as  to  form  a cavity 
resembling  a sack  ; attached  to  the  stomach  by  its  ante- 
rior, and  to  the  colon  by  its  posterior  fold ; hanging 
between  the  anterior  parietes  of  the  abdomen  and  in- 
testines ; extending  commonly  as  low  as  the  umbili- 
cus. It  consists  of  two  thin  membranes,  united  by 
cellular  substance,  and  ia  well  supplied  with  blood- 
vessels. The  cellular  substance  uniting  these  two 
membranes  is  the  seat  of  the  fat,  which  is  the  more  im- 
mediate object  of  this  essay. 

The  uses  ascribed  to  the  omentum  have  been  many 
and  various ; some  of  those  generally  received  shall  be 
the  objects  of  consideration. 

I.  Its  office  has  been  supposed  to  prevent  the  injuries 
from  the  friction  of  the  intestines  upon  each  other,  by 
furnishing  an  oleaginous  fluid  to  lubricate  them. 

It  has  long  been  the  practice  of  physiologists,  to 
measure  the  intentions  of  nature  by  their  own  ingenu- 
ity. Hence  the  explanations  of  the  pulsations  of  the 
heart ; of  the  equilibrium  given  to  the  body  by  the 
spleen  ; and  of  the  lubricating  quality  of  the  omentum. 
I object  to  this  opinion,  first,  because  it  is  too  mechani- 
cal. Although,  strictly  considered,  every  natural  opera- 
tion must  be  mechanical,  yet  physiology  has  often  suf- 
fered from  a confusion  of  the  attenuated  laws  of  vital 
action,  with  the  grosser  rules  of  the  arts  or  mechanism 


12 


of  common  life.  Secondly,  it  is  not  necessary . We 
know  that  moisture  alone,  is  sufficient  to  give  facility 
of  motion  to  parts  pliant  and  polished ; now  the  in- 
testines are  under  these  circumstances,  with  regard  to 
themselves,  and  the  peritoneum.  Thirdly,  by  its  fat 
it  cannot  lubricate  the  intestines . The  omentum  is 
not  a fat-secreting  surface,  but  a fat-containing  cavi- 
ty : its  surface  affording  nothing  except  that  moisture 
which  is  natural  to  all  internal  membranes,  and  this 
I have  spoken  of  as  abundantly  supplied  without  the 
aid  of  the  omentum.  Fourthly,  the  supposition  that 
it  is  to  prevent  friction , only  substitutes,  for  attrition, 
a substance  less  regular  and  yielding  than  the  peritone- 
um it  is  intended  to  cover. 

II.  A second  use  which  has  been  ascribed  to  the 
omentum  is,  that  it  is  intended,  with  other  abdominal 
viscera,  to  prepare  blood  for  the  formation  of  bile. 
Here,  from  an  accidental,  and  at  the  same  time  an  un- 
avoidable circumstance,  is  deduced  a conclusion  not 
warranted  by  any  proof : accidental,  as  the  liver  was 
placed  in  the  cavity  of  the  abdomen,  and  unavoidable , 
as  it  could  receive  its  blood  from  the  viscera  of  no 
other  part.  If  we  infer  from  this  situation  of  the  liver, 
that  a change  takes  place  in  the  blood  of  the  vena  por- 
tarum,  this  change  must  be  produced  by  each  particu- 
lar viscus,  or  it  must  be  the  joint  operation  of  all.  It 
cannot  be  the  former,  for  each  of  the  several  parts  se- 
creting a different  substance  from  the  blood,  must  give 
a different  quality  of  blood  to  be  returned.  If  it  be  the 


13 


latter,  disease  in  those  parts  must  prevent  the  formation 
of  the  peculiar  hepatic  blood.  Let  it  not  be  said,  that 
disease  or  obstruction  of  these  preparing  viscera  is 
often  attended  or  followed  by  fatal  consequences  to  the 
system.  To  this  it  may  be  answered,  that  these  parts 
are  vital  in  other  respects  than  their  relation  to  the  cir- 
culation of  the  blood.  Moreover,  if  the  bile  require 
this  oily  secretion,  why  is  the  fat  thrown  out  into  cells  ? 
It  ought  to  pass  directly  on  to  the  liver  through  the 
veins ; as  this  is  not  its  course,  it  can  get  there  only- 
through  the  medium  of  the  absorbents.  To  suppose  it 
first  secreted,  effused  into  cavities,  and  afterwards  taken 
up  by  lymphatics,  is  to  admit  a prolix,  where  nature  has 
a more  simple  process. 

This  opinion  is  grounded  upon  the  fact,  of  fat  being 
found  in  the  omental  branches  of  the  vena  portarum ; 
and  from  this  has  been  explained  the  oily  nature  of  the 
bile.  The  inference  from  this  fact  is,  that  the  liver 
is  not  a secretory  organ,  but  a filter.  It  is  impos- 
sible however  that  acini  so  minute  as  to  prevent  the 
passage  of  blood,  should  give  admission  to  so  viscid 
a substance  as  fat,  of  such  a size  as  to  be  the  object  of 
examination  by  the  eye.  The  bile  does  not  derive  its 
oily  nature  from  the  fat ; we  have  seen  that  it  cannot 
pass  by  filtration,  it  must  undergo  the  secretory  ac- 
tion. Now  the  very  essence  of  secretion  is  an  altera- 
tion of  chemical  properties,  which  if  the  fat  suffer,  it 
cannot  form  the  oil  of  the  bile,  for,  take  the  most 
minute  portion  of  its  principles  away,  and  you  destroy 
its  nature  as  fat. 


14 


III.  A third  opinion  advocated  for  the  use  of  this  vis- 
cus,  is  that  it  serves  to  keep  the  intestines  warm.  If  this 
should  need  a refutation,  I would  observe : First,  it 
will  apply  only  to  hybernating  animals.  In  their  living 
state,  nature  has  prevented  the  evil  arising  from  a de- 
fect of  warmth,  by  placing  these  viscera  near  the  great- 
est source  of  heat.  Secondly,  if  it  were  true,  die 
want  of  such  a provision  would  be  felt  elsew  here. 
Why  has  not  the  brain  its  hood,  or  why  is  the  thorax 
without  its  breast- plate  ? 

This  opinion  is  deduced  from  the  fact,  that  very  fat 
people  feel  the  cold  less  sensibly  than  those  who  are 
lean.  But  this  is  to  be  ascribed  to  the  effect  it  has 
upon  the  nerves.  Richerand,  in  speaking  of  the  uses 
of  the  fat,  says,  “ and  finally,  it  covers  and  surrounds 
the  extremities  of  the  nerves,  diminishing  their  suscep- 
tibility, which  is  always  in  an  inverse  proportion  to  cor- 
pulency.”  Again,  “ In  fact,  persons  subject  to  nervous 
affections,  constantly  join  an  extreme  leanness  to  an  ex- 
cessive sensibility 

Other  opinions  of  the  uses  of  this  organ  have  been 
proposed.  They  will  be  omitted  to  give  place  to  one, 
to  the  support  of  which  the  following  pages  shall  be 
devoted. 

I shall  endeavour  to  prove  the  omentum  to  be  an  or- 
gan for  the  secretion  of  fat , furnished  with  vesicula  for 
its  reception , in  order  to  supply  the  body  with  nourish- 
ment, when  the  resources  by  the  stomach  fail. 


* Physiology.  Article  Ixxvi. 


15 


The  arguments  for  the  support  of  this  proposition 
will  be  deferred,  till  the  consideration  of  some  circum- 
stances which  are  connected  with  this  view  of  the  sub- 
ject. 

That  fat  nourishes  the  body  in  certain  states  is  no 
new  idea ; the  phenomena  of  its  existence  were  too  ob- 
vious not  to  lead  to  that  conclusion.  As  an  old  doc- 
trine, it  has  little  meaning.  Blood  is  the  only  medium 
of  nourishment  with  which  we  are  acquainted ; but  the 
fat  has  not  yet  become  blood.  How  is  this  effected  ? 
It  may  be  said  that  it  is  produced  by  the  lymphatics 
and  their  glandular  system.  This  may  be  answer- 
ed, by  observing,  First,  whatever  change  is  the  effect 
of  their  action,  it  is  certain  they  do  not  completely  con- 
vert it  into  blood  ; nay,  they  do  not  even  form  a chylous 
substance,  but  a more  limpid  fluid.  Secondly,  fat  has 
been  found  in  the  branches  of  the  vena  portarum.  A 
sufficient  proof  that  it  has  passed,  with  little  or  no  alter- 
ation, the  action  of  the  lymphatics  : it  being  immaterial 
whether  it  has  gotten  into  the  veins  by  a set  of  partial 
vessels,  or  has  passed  the  circle  of  the  general  absor- 
bent system.  The  change  then  must  be  made  after  it 
enters  the  circulation,  and  nowhere  is  there  a cause  ade- 
quate to  that,  except  in  the  lungs  or  the  liver.  It  can- 
not be  in  the  lungs,  for  chyle  has  been  found  in  the 
blood  after  it  has  passed  through  them. 

It  remains  then  for  the  liver  to  perform  the  office  in 
question,  and  this  I shall  now  consider  more  in  de- 
tail. 


16 

“ The  design  of  the  liver,”  says  the  author,  in  the 
essay  referred  to,  “I  believe  to  be,  to  receive  the  blood 
from  every  part  of  the  body,  in  order  to  subject  that 
part  of  it  which  has  not  been  completely  animalized, 
or  divested  of  its  chylous  properties,  to  a secretory 
process,  and  afterwards  to  pour  the  product  of  this 
secretion,  mixed  with  the  liquor  of  the  pancreas,  into 
the  duodenum,  to  be  absorbed  or  otherwise  taken  up 
by  the  lacteals,  and  conveyed  with  the  chyle  from  the 
stomach  iiiio  the  bloocl-vessels,  in  order  to  be  com- 
pletely converted  into  red  blood,  for  the  purpose  of 
serving  the  various  and  important  uses  for  which  that 
fluid  is  intended  in  the  human  body.”  It  would  con- 
sume too  much  time  to  give,  at  large,  the  facts  and  rea- 
sonings used  by  the  author  to  support  this  proposition. 
I shall  give  an  abstract  of  them.  The  same  power  that 
perfects  the  chyle,  converts  the  fat  to  a like  matter ; and 
as  this  is  one  of  the  ideas  embraced  by  this  essay,  its 
proof  may  be  required. 

The  arguments  in  support  of  this  doctrine  are, 

“ 1st.  The  presence  of  the  liver,  in  nearly  all  ani- 
mals, being  in  this  respect  on  a footing  with  the  sto- 
mach.” 

“ 2d.  The  immense  and  disproportionate  size  of 
the  liver  in  the  foetus,  compared  with  that  of  the  adult, 
the  design  of  which  appears  to  be,  that  nourishment 
may  be  carried  on  exclusively  by  that  viscus,  without 
any  aid  from  the  stomach.” 


17 

£t  3d.  The  size  of  the  liver  in  adults,  and  4he  quan- 
tity of  bile  secreted,  said  by  Haller  to  be  twenty -four 
ounces  in  24  hours.” 

“ 4th.  Chyle  has  been  found  in  the  blood  after  it 
has  passed  through  the  lungs ; hence  it  requires  another 
process.” 

“ 5th.  The  quality  of  the  venous  blood  from  which 
the  bile  is  secreted.  It  is  less  disposed  to  putrefaction 
than  arterial  blood  in  any  part  of  the  body.  This  arises 
from  the  chyle  it  contains,  as  chyle  is  less  putrescent 
than  blood.” 

“ 6th.  The  quality  of  hepatic  bile,  it  being  sweet. 
Haller  says,  “dulcior  hepatica  cystica  arnara. ” 

“ 7th.  Sever  4 experiments  of  Dr.  Fordyee  prove 
chyle  to  be  formed  by  the  action  of  saliva  and  gastric 
juice  upon  the  aliment,  without  the  mixture  of  hepatic 
bile.” 

“ 8th.  The  structure,  situation,  and  function  ot  the 
pancreas.  It  resembles  the  salivary  giands  in  its  struc- 
ture ; it  secretes  a liquor  which  possesses  the  same  dis- 
solving and  animalizing  properties  as  the  saliva  ; and  it 
pours  this  liquor  so  directly  upon  the  hepatic  bile,  as  to 
change  it  into  perfect  chyle.” 

“ 9th.  It  is  inferred  that  a second  chylopoietic  pro- 
cess goes  on  in  the  liver,  from  the  effects  of  intempe- 
rance upon  it.  It  increases  its  labour,  and  thereby  in- 
creases its  size.” 

To  the  above  arguments  in  support  of  this  opinion 
of  the  function  of  the  liver,  I shall  add  the  foil  on  ing  ob- 
servations. Doctor  Pemberton,  in  his  treatise  upon  the 


c 


18 


diseases  of  the  viscera*,  has  taken  a view  of  the  glands 
of  the  body,  as  divided  into  those  that  secrete  a fluid 
from  the  blood  for  the  use  of  the  system,  and  those  that 
secrete  a fluid  to  be  discharged  from  it.  The  former 
he  has  called  glands  of  supply  ; the  latter,  glands  of 
waste.  He  has  satisfactorily  shown,  that  derangements 
of  the  glands  of  waste  are  not  attended  by  any  altera- 
tion ill  the  bulk  of  the  body ; whereas  disease  in  the 
glands  of  supply,  in  almost  every  case,  produces  emaci- 
ation. The  liver  is  an  organ,  the  diseases  and  disorders 
of  which  cause  a wasting  of  the  flesh.  This  gives  it  a 
place  among  the  glands  of  supply.  I would  however 
infer  that  it  serves  this  purpose,  more  than  is  generally 
allowed  ; for  if  so  great  a quantity  of  bile  as  24  ounces, 
which  is  secreted  in  24  hours,  be  not  excrementitious, 
how  considerable  must  its  effect  be  in  nourishing  the 
body  ! It  is  known  that  gall-stones  obstructing  the 
biliary  ducts  produce  emaciation.  This  has  been  as- 
cribed to  the  effect  of  the  irritation  of  pain  upon  the 
system.  I would  rather  suppose  it  to  be  owing  to  the 
obstruction  to  the  flow  of  bile,  when  the  stone  is  in  the 
ductus  communis ; and  when  it  is  in  the  cystic  duct, 
to  the  irritation,  by  continuous  sympathy,  causing  a 
vitiated  secretion  of  bile. 

With  these  views  of  the  liver  as  established  premi- 
ses, I shall  proceed  to  exhibit  the  proofs  of  the  proposi- 

* See  “A  Practical  Treatise  on  Various  Diseases  of  the  Abdo- 
minal Viscera,”  by  C.  R,  Pemberton. 


19 

tion  laid  down,  on  the  subject  of  the  intention  of  the 
omentum. 

This  viscus  seems  not  to  be  one  of  those  whose  use 
is  inscribed  upon  it  so  legibly,  as  not  to  need  the  efforts 
of  reason  to  decypher  it.  The  appearance  it  exhibits 
to  the  eye,  is  not  sufficient  to  manifest  its  operations.  It 
is  of  such  inconsiderable  importance  to  the  animal  sys- 
tem, as  not  to  give  by  its  own  derangements  any  very 
sensible  alteration  to  the  functions  of  the  body,  or  at 
any  rate  it  has  its  office  vicariously  supplied.  From 
this  view  we  may  see  why  the  separation  of  parts  of  it, 
its  adhesions,  and  every  other  preternatural  state  of  it, 
have  so  little  effect  upon  the  body.  Hence  too  the  dif- 
culty  and  inefficacy  of  any  experiments,  to  which  it  could 
be  subjected.  There  exist,  however,  facts  enough  con- 
nected with  its  ordinary  phenomena,  as  exhibited  after 
disease,  to  afford  just  conclusions  of  its  use.  To  this 
add  its  fitness  for  the  office  here  ascribed  to  it.  For 
though  the  sufficiency  of  a cause  be  not  an  undeniable 
argument  for  its  agency,  yet  it  is  essential  to  proof. 

It  has  been  said  before,  that  the  omentum  is  an  organ 
for  the  secretion  of  fat , furnished  with  cells  for  its  re- 
ception. This  is  true,  whatever  be  the  intention  of  the 
fat  when  secreted.  It  is  true,  because  it  is  seen.  I 
know  of  no  other  argument  for  its  proof.  Beside 
the  evidence  of  our  senses,  proof  requires  the  media- 
tion of  axioms.  There  is  no  assertion  more  self-evi- 
dent. I might  indeed  vary  its  form,  but,  like  the  revo- 


lutions  of  a sphere,  it  would  not  bring  a greater  com 
pass  into  view*. 

The  second  part  of  the  proposition  to  be  considered 
is,  that  the  omentum  is  intended  for  the  purpose  of  sup- 
plying the  body  with  nourishment  when  the  resources  by 
the  stomach  fad.  My  behei  in  this  arises  from  the 
following  <ic 

1st.  From  the  situation  of  the  omentum,  being  in  that 
part  of  the  bod}  where  it  can  afford  none  of  those  offi- 
ces, which  the  fat  in  other  paita  of  the  system  supplies. 
These  are,  giving  shape  to  the  body,  lubricating  for  the 
advantages  of  motion,  filling  up  unavoidable  cavities, 
and  serving  as  the  envelope  of  some  viscus  or  organ. 
Here  is  no  rugged  angle  of  feature  to  be  smoothed. 
Here  is  no  eye  whose  delicateness  the  contact  of  bone 
would  injure. 

2d.  From  its  little  sensibility , known  from  the  re- 
moval of  parts  of  it,  and  from  its  circumstances  in  hernia 
and  wounds.  From  this  I would  infer  an  aptitude  for 
its  intention  to  admit  of  variation  in  its  size  by  its  dis- 
tention with  fat : a property  which,  had  it  not  pos- 
sessed, w ould  have  subjected  it  to  the  inconveniences 
of  pain. 

3d.  From  its  presence  in  so  many  animals,  taken  in 
conjunction  with 

4th.  Its  absence  in  others.  It  w ould  be  tedious  to 
enumerate  the  different  animals  in  which  this  viscus  is 
found,  as  well  as  those  in  whom  it  is  wanting.  The 

* Perhaps  we  might  urge  its  great  vascularity,  and  its  diseases, 
hydatids  and  sehirrus,  in  favour  of  its  being  a secretory  organ 


21 


exceptions  to  it,  give  the  best  idea  of  its  use.  For 
here,  as  in  the  forms  of  mathematical  evidence,  the 
substitution  is  more  easily  understood.  When  the 
omentum  is  wanting,  its  place  is  supplied  by  a substance 
which  allows  scarcely  a doubt  of  its  use,  and  to  ascribe 
to  that  substance  the  generally  received  uses  of  the 
omentum,  would  be  absurd.  There  is  only  one  office, 
which  these  adipose  substances  appear  capable  of  afford- 
ing, and  that  is,  the  nourishment  of  the  body  by  their 
fat.  This,  indeed,  is  universally  allowed.  Haller, 
speaking  of  the  use  of  the  omentum,  says:  “ Qua  ta- 

men  animalia  omento  destituunter,  iis  adipis  massa  pro 
omento  est ; avibus  nempe  aquaticis  aliisque  et  pisci- 
bus*.”  But  without  the  argument  arising  from  this 
circumstance,  even  were  this  substitute  wanting,  still 
its  absence  would  not  be  an  unanswerable  objection. 
The  qualities  that  animals  possess  are  variously,  but 
not  partially  bestowed.  Hence  the  want  of  one  is  sup- 
plied by  the  presence  of  another  similar  to  it,  or  equally 
important.  If  the  omentum  should  be  wanting  in  some 
animals,  this  would  not  prove  that  they  were  denied  the 
advantages  that  others  received  from  it,  or  that  it  was 
useless  in  those  that  had  it.  It  would  be  explained  by 
these  three  circumstances : first,  that  the  animals  had 
other  peculiarities  of  structure,  as  important;  secondly, 
that  fat  was  to  them  not  so  necessary ; or,  thirdly,  that 
the  existence  of  this  fat  would  be  inconsistent  with 
some  other  property  more  advantageous  to  the  animal. 


Elementa  Phys,  vol.  vi,  p,  381. 


22 


5th.  I infer  the  use  I have  ascribed  to  this  viscus 
from  the  state  of  the  omentum  in  hybernating  animals . 
Besides  the  quantity  of  fat  throughout  the  cellu- 
lar membrane  generally,  and  an  omentum  much  dis- 
tended with  it,  these  animals  have  two  lateral  appendices, 
like  the  omentum  in  their  structure  and  intention. 
Haller  speaks  of  this  appearance  in  some  of  these  ani- 
mals, “ ut  sint  tria  quasi  omentaf.”  Now,  what  is 
the  occasion  of  this  great  provision  ? The  only  circum- 
stance that  distinguishes  these  animals  from  others,  is 
their  remaining,  for  a certain  time,  without  the  resour- 
ces of  the  stomach  for  food.  Corresponding  to  this  is 
the  state  of  the  omentum.  There  is  no  other  peculi- 
arity of  these  animals  that  requires  this  difference. 
There  is  not  more  need  for  lubrication,  not  more  oil 
required  for  the  bile,  nor  is  it  necessary  for  any  other 
of  the  imaginary  uses  ever  ascribed  to  the  omentum. 

The  views  arising  from  this  class  of  animals  are  so 
interesting  to  the  subject,  that  they  will  be  considered 
more  fully. 

Cuvier,  in  his  observations  on  this  subject,  mentions 
a fact,  which,  by  indicating  a use  for  the  omentum, 
seems  to  be  an  objection  to  that  one  I wish  to  establish. 
“ Le  grand  epiploon , suspendu  comme  un  rideau  entre 
les  parois  musculeuses  du  bas-ventre,  et  les  circonvo- 
lutions  des  intestins,  modere  sans  doute  un  peu  les 
froissemens  que  ceux-ci  pourroient  eprouver  des  pre- 


* Haller’s  Physiology,  vol.  vi,  p.  381. 


23 


mieres,  et  sert  particulierement  a retenir  dans  les  intes- 
tins  la  chaleur  qui  tend  continueHement  a s’echapper 
vers  la  circonference.  L’histoire  des  membranes  grais- 
seuses  dans  les  animaux  qui  hibernent,  va  nous  con- 
firmer dans  cette  derniere  opinion.  Lorsque  l’estomac 
est  plein  d’alimens,  cet  epiploon  est  raccourci  et  releve 
sur  sa  face  anterieure,  de  maniere  a la  recouvrir  plus 
completement  qu’avant.  II  rend  alors  plus  particu- 
lierement a ce  viscere  le  service  que  nous  venons  de 
lui  attribuer  a l’egard  des  intestins.  En  meme  temps 
le  sang  passant  moins  facilement  dans  ces  vaisseaux, 
coule  plus  abandomment  dans  ceux  de  l’estomac,  dont 
les  premiers  ne  sont  que  des  divisions,  et  y separe  une 
plus  grande  abondance  des  sues  gastriques*.” 

What  seems  to  be  of  importance  here  is,  that  the 
omentum  is  found  investing  the  stomach,  whilst  it  is 
employed  in  digestion.  A little  inquiry  will  give  this 
an  explanation.  Observations  on  animals  with  the  sto- 
mach thus  enveloped,  have  been  made  when  the  animal 
was  in  its  living  state,  well  supplied  with  aliment  from 
the  food  it  was  taking,  and  before  the  store  of  fat  was  laid 
up  for  its  winter  support.  Now,  that  a membrane, 
thin  and  vacillating,  should,  by  the  constant  peristaltic 
motion  of  the  intestines,  be  contorted  from  its  natural  de- 
pendent situation,  is  not  extraordinary,  but  purely  acci- 
dental and  natural.  Before  the  action  of  the  stomach 
has  ceased  to  be  required,  the  wants  of  the  animal  have 


* Lecon  xxii,  p.  86. 


2 4 


called  for  an  accumulation  of  fat.  When  the  cells  of 
the  omentum  have  become  distended,  the  most  econo- 
mical  situation  for  this  membrane  is  extended  and  flat. 
Hence  it  leaves  the  stomach,  and  is  spread  upon  the  in- 
testines. But  why,  according  to  Cuvier’s  idea,  does 
this  change  take  place  ? The  bowels  are  not  more  ac- 
tive than  the  stomach  ; nor  is  there  any  other  reason 
why  they  require  more  warmth.  The  last  part  of  this 
quotation  supposes  that  another  advantage  is  given  to 
the  stomach,  by  this  folding  of  the  omentum  causing 
a greater  secretion  of  gastric  liquor.  This  is  not  the 
only  viscus  to  which  this  office  of  supplying  blood  to 
the  stomach,  has  been  ascribed.  The  spleen  is  even 
yet  supposed  to  be  for  that  purpose.  They  are  both 
equally  untrue.  The  greater  flux  alone  of  blood  in  any 
viscus,  never  tends  to  increase  its  secretions.  This  is 
proved  by  the  phenomena  of  the  circulation  and  of  fe- 
vers. Exercise  is  not,  when  violent,  immediately  fol- 
lowed by  an  increase  of  all  the  secretions;  nor  are  in- 
flammations of  the  liver  and  kidneys  always  attended  by 
a preternatural  flow  of  bile  or  urine.  An  unusual 
quantity  of  blood,  in  any  part,  produces  disease,  or  is 
disease  itself.  It  would  be  well,  if,  by  secretion,  an 
organ  could  thus  easily  rid  itself  of  its  irritating  cause. 
Celerity  or  energy  of  chemical  attractions  alone,  can 
give  rapidity  to  secretion. 

Some  of  the  species  of  the  hybernating  animals  arc 
destitute  of  the  omentum.  The  account  given  of  such 
animals  will  sufficiently  obviate  any  objection  that 
might  arise  from  it.  Cuvier,  in  speaking  of  the  hy- 


25 


foernating  class,  says,  “ Les  oiseaux  des  mceurs  analo- 
gue, tels  que  l’hirondelle  de  marais,  plusieurs  reptiles 
que  hibernent  de  meme  sont  depourvus  aussi  de  ces 
membranes  graisseuses ; il  est  vrai  que  leur  peritoine 
se  charge  pendant  l’hiver  frune  graisse  abondante .” 

6th.  From  the  defect  of  fat  in  the  omentum  of  the 
foetus.  “ Tenue  in  fetu,  in  adulto  homine  varie  obe- 
sum*.”  This  is  a fact  of  great  importance.  In  the 
foetal  state  the  supply  of  nourishment  is  nearly  uniform. 
The  minute  arterial  connection  of  the  placenta  with  the 
uterus,  prevents  the  effects  of  a hurried  or  disordered 
circulation  upon  the  foetus.  Hence  there  is  but  little 
alteration  of  the  volume  of  blood  sent  to  it,  under  every 
irregularity  of  the  mother.  With  such  a constant  and 
unvaried  supply,  the  office  of  the  omentum  in  the  foetus 
would  have  been  unnecessary.  Soon  after  birth  the  fat 
is  deposited,  for'  then  the  want  of  it  begins  to  be  felt. 

7th.  I infer  it,  from  its  distention  with  fat  more  parti- 
cularly than  any  part  of  the  body,  in  those  disposed  to 
obesity.  Whatever  purpose  the  fat  serves,  that  must  be 
more  eminently  in  view  in  the  omentum,  as  it  contains  the 
greatest  quantity.  It  has  been  shown  that  its  offices  in 
other  parts  of  the  body  have  no  concern  here.  Its 
more  obvious  and  important  intention  of  serving  as 
nourishment,  alone  remains  of  its  uses. 

8th.  From  its  state  when  divested  of  fat ; being  redu- 
ced to  a slender  contracted  membrane,  and  so  much  di- 
minished, as  to  be  apparently  not  fitted  for  any  purpose 

* Elementa  Phys.  vol.  vi,  page  367. 

T) 


26 

in  the  animal  economy.  The  histories  of  dissections 
contain  many  accounts  of  a partial  or  total  loss  of  this 
viscus.  Of  these  I shall  mention  one,  as  quoted  by 
Portal,  in  the  case  of  a patient  who  had  died  of  pulmo 
ry  consumption.  “ The  other  viscera  were  flaccid, 
pale,  and  void  of  blood.  The  omentum  was  destroyed , 
and  the  body  reduced  to  such  a degree  of  emaciation,  as 
to  resemble  a very  skeleton*.”  Here  it  was  not  destroy 
ed,  as  parts  of  the  body  often  are,  by  local  disease,  nor 
was  it  absorbed,  as  parts  are  when  removed  from  their 
natural  situation.  But  in  a phthisical  subject,  where 
the  cause  of  the  death  was  seated  in  the  lungs,  its  dis- 
appearance could  have  arisen  only  from  the  great  de- 
mand for  nourishment,  which  attends  this  lingering  dis- 
ease. Not  only  in  this  case  was  the  fat  absorbed,  but 
its  whole  substance,  as  if  the  membranes,  when  they 
had  lost  their  contents,  being  useless,  were  themselves 
taken  for  food.  Perhaps  the  ludicrous  observation 
made  by  Mr.  Bell,  of  the  impossibility  of  lymphatics 
absorbing  themselves,  might  be  urged  here.  I cannot, 
however,  see  any  more  error  in  it,  than  in  the  intus- 
susceptio  and  sphacelation  of  an  intestine.  But,  even 
admitting  the  impossibility  of  this,  certainly  one  lym- 
phatic may  absorb  another.  It  will  be  no  objection  to 
this  to  say,  that,  whilst  the  vessel  is  in  a living  state,  it 
cannot  be  subject  to  the  laws  of  inorganized  matter. 
In  reality  I know  no  difference  between  the  laws  ol 

* Observations  snr  la  Nature  et  sur  le  Traitement  de  la  Phthise 
Pulvnonaire,  par  Antoine  Portal.  Page  227. 


27 

living  and  of  lifeless  matter ; but,  according  to  either 
idea,  the  invisible  particles,  which  are  taken  up  by  the 
absorbents,  have  not  the  property  which  common  obser- 
vation makes  the  characteristic  of  life,  that  is,  organi- 
zation or  vascularity. 

9th.  From  the  structure  of  the  omentum.  It  is  vas- 
cular for  the  secretion,  and  cellular  for  the  reception  of 
fat,  and  is  provided  with  lymphatics  for  its  removal. 

10th.  Lastly,  I infer  that  the  intention  of  the  omentum 
is  to  afford  nourishment  to  the  body,  from  the  connec- 
tion of  certain  states  of  this  viscus  with  the  diseases  of 
the  liver.  The  fat  of  the  body,  without  a liver  to 
change  it,  would  have  been  useless  as  to  its  most  im- 
portant property.  The  diseases  of  the  latter  might  be 
supposed  to  have  an  influence  upon  the  former,  and  ac- 
cordingly a diseased  liver  has  been  found,  in  many  in- 
stances, to  be  accompanied  by  an  unnatural  state  of  the 
omentum.  In  some  cases  where,  it  is  true,  this  vis- 
cus should  have  been  deprived  of  fat,  it  has  been 
found  preternaturally  distended  with  it.  But,  for- 
tunately for  my  argument,  the  liver  has,  in  these  cases, 
been  also  diseased.  I admit,  it  may  be  shown  from  the 
accounts  of  dissections,  that  the  liver  has  been  disordered, 
and  yet  the  fat  of  the  omentum  properly  absorbed  ; nay, 
the  membranes  which  inclose  it  have  been  destroyed. 
This  I shall  answer  by  observing,  first,  that  a diseased 
appearance  in  the  substance  of  the  liver,  does  not  prove 
a derangement  of  its  secreting  organs  ; and,  secondly, 
admitting  this,  much  more  knowledge  on  the  sub- 
ject is  required  to  determine  that  these  alterations  did 


28 


not  take  place  before  the  liver  became  thus  diseased. 
It  is  sufficient,  then,  if  I can  give  one  or  two  instances 
of  this  correspondence  in  disease,  in  the  two  viscera ; 
the  exceptions  are  explained  by  the  two  foregoing  ob- 
servations. 

Lieutaud  mentions  some  cases  of  this  kind.  I shall 
relate  one  of  them.  In  his  observation  227,  he  says, 
“ Quidam  consistensibus  eetatis  obesus,  et  jam  dudum 
asthmaticus ; tandem  in  ischuriam  lethalem  incidit. 
Secto  cadavere,  deprehenditur  omcntem,  ob  majorem 
adipis  copiam ; et  pondo  trigenti  librarum.  Hepar 
or  at  mole  maximum .” 

In  Heister’s  observations*  is  related  the  case  of  a pa- 
tient who  died  of  extreme  emaciation  generally,  but  in 
whom  the  omentum  was  found  “ very  fat.”  He  had 
before  death  been  long  troubled  with  a diarrhoea,  which 
indeed  indicated  a disease  of  the  liver,  and  the  dissection 
proved  that  viscus  to  be  in  a morbid  state.  But  what  was 
of  much  more  importance,  as  it  proved  the  secretion  of 
that  organ  to  be  altered,  was  that  the  patient,  during  his 
illness,  was  troubled  with  eructations  of  matter  resem- 
bling “ bile  in  being  acrid,  but  destitute  of  its  bitter  or 
acid  taste.” 

Here  was  a case,  where,  from  the  wasting  diarrhoea 
that  attended,  no  fat  would  have  been  expected  to  be 
found  in  the  body ; and  yet  here, is  an  omentum  loaded 
with  it.  The  liver  was  diseased,  and  incapable  of  con- 
verting the  fat  to  nourishment.  In  this  state,  then, 
there  was  no  need  of  absorption,  and  consequently  we 


* Observation  ccclxxxii. 


29 

find  none.  It  may  be  said,  that,  as  it  had  disappeared 
from  the  other  parts  of  the  body,  may  not  some  other 
cause  than  the  disease  of  the  liver  have  been  the  reason 
why  it  also  was  not  taken  up  ? This  I would  answer 
by  observing,  first,  that  the  fat  of  the  other  parts  of  the 
body  being  less  in  quantity  than  in  the  omentum,  would 
be  much  sooner  absorbed,  and  this  may  have  taken 
place  before  the  liver  was  so  far  deranged  as  to  be  in- 
capable of  the  office  of  chylification ; or,  secondly,  if 
it  shows  the  agency  of  any  other  cause,  it  is  that  the 
lymphatics  of  the  omentum  and  the  other  parts  of  the 
body  have  different  degrees  of  power ; a fact  that  would 
turn  to  my  advantage  ; for,  if  the  fat  in  the  two  situa- 
tions have  different  intentions,  we  should  expect  to  find 
some  of  their  other  circumstances  different. 

Mr.  Proust,  in  his  Dissections*,  relates  a case  that 
helps  to  illustrate  this  question.  A patient,  who  had 
been  much  troubled  with  bilious  complaints,  was  seized 
with  indigestion  and  vomiting;  and  these  were  suc- 
ceeded by  a diarrhoea,  of  which,  after  three  weeks’  con- 
tinuance, he  died.  On  opening  the  body,  much  fat 
was  found  everywhere,  and  the  omentum  “ entirely 
occupied  by  it.”  The  liver  was  of  a remarkable  size . 
Now,  if  any  thing  could  have  given  rise  to  an  absorp- 
tion, it  would  have  been  the  wasting  of  a diarrhoea, 
and  the  want  of  nourishment  which  a diseased  stomach 
must  have  occasioned.  Yet  here  is  a body  “ embon- 
point asset  f to  use  his  own  words. 


* Observation  xxv. 


30 


The  pulmonary  consumption,  more  than  any  other 
disease,  is  attended  by  an  emaciation,  arising,  most 
probably,  from  the  chronic  nature  of  that  complaint. 
It  is  certain  that  the  proper  and  natural  supply  of  ma- 
terials for  the  action  of  any  viscus  are  necessary  for  its 
health.  Perhaps,  then,  the  diseases  of  the  liver  that 
attend  upon  consumption,  arise  from  its  want  of  the 
proper  substance  for  its  action.  Perhaps,  too,  the  want 
of  that  natural  supply  gives  rise  to  a vitiated  secretion, 
which  may  be  the  cause  of  the  wasting  diarrhoea  that 
commonly  terminates  that  disease. 

Concerning  the  disappearance  of  fat  by  disease,  it 
deserves  to  be  remarked,  that  by  fasting  the  action  of 
the  lymphatics  is  increased.  If  it  were  not  so,  fat 
could  not  be  removed.  Now,  we  know  that  the  want 
of  food  by  the  stomach,  almost  always  causes  an  ab- 
sorption of  fat*. 


• * Perhaps,  under  this  remark,  it  might  not  be  amiss  to  notice 
the  practical  benefit  to  be  derived  from  this  disposition  of  the 
lymphatics  to  take  on  a preternatural  action  during  fasting.  It 
teaches  us  to  endeavour,  by  abstinence,  to  promote  the  absorption 
of  collections  of  water  in  dropsy.  That  it  should  not  oftener  suc- 
ceed, is  owing  to  the  interference  of  some  cause  that  continues  the 
disease.  If  the  removal  of  water  were  the  only  obstacle  to  the 
cure  of  dropsy,  I have  no  doubt  that  abstinence  would,  in  almost 
every  case,  be  effectual.  There  are  many  instances  on  record  ol 
the  advantage  of  this  remedy.  I shall  relate  one  from  Sir  John 
Hawkins’s  Life  of  Dr.  Johnson. 

“ A few  days  after,”  says  sir  John,  “ he  (Dr.  Johnson)  sent  for 
me,  and  informed  me,  that  he  had  discovered  in  himself  the  syrup* 
toms  of  a dropsy,  and,  indeed,  his  very  much  increased  bulk,  and 


31 


I have  thus  gone  through  the  several  heads  of  the 
reasons  for  my  belief  on  this  subject.  If  any  one  or 
two  of  them  appear  not  conclusive,  or  even  objection- 
able,  let  it  be  remembered  that  the  evidence  does  not 
rest  upon  them  alone.  If  the  whole,  taken  together, 
should  amount  to  proof,  it  is  sufficient. 

There  remain  yet  some  facts,  connected  with  the 
subject,  which,  not  being  referrible  to  any  of  the  fore- 
going heads,  may  properly  be  considered  here. 

It  is  said  that  the  omentum  of  herbivorous  animals 
is  in  general  more  fat  than  that  of  carnivorous.  It  is 
also  said  that  the  same  peculiarity  distinguishes  those 
whose  motions  are  sluggish,  from  those  whose  habits 

the  swollen  appearance  of  his  legs,  seemed  to  indicate  no  less.  It 
was  on  Thursday  that  I had  this  conversation  with  him ; in  the 
course  thereof  he  declared,  that  he  intended  to  devote  the  whole  of 
the  next  day  to  fasting , humiliation,  and  such  other  devotional 
exercises  as  became  a man  in  his  situation.  On  the  Sunday  fol- 
lowing I made  him  a visit,  and,  upon  entering  his  room,  I observed 
in  his  countenance  such  a serenity,  as  indicated  that  some  remark- 
able crisis  of  his  disease  had  produced  a change  in  his  feelings. 
He  told  me,  that,  pursuant  to  the  resolution  he  had  mentioned  to 
me,  he  had  spent  the  preceding  day  in  an  abstraction  from  all 
worldly  concerns;  that,  to  prevent  interruption,  he  had  in  the 
morning  ordered  Frank  (his  servant)  not  to  admit  any  one  to  him, 
and,  the  better  to  enforce  his  charge,  had  added  these  awful  words, 
for  your  master  is  preparing  himself  to  die.  He  then  mentioned 
to  me,  that,  in  the  course  of  this  exercise,  he  found  himself  re- 
lieved from  the  disease  which  had  been  growing  upon  him,  and 
was  becoming  very  oppressive,  viz.  the  dropsy , by  the  gradual 
evacuation  of  water,  to  the  amount  of  twenty  pints;  a like  instance 
whereof  he  had  never  before  experienced.” 


32 


of  life  are  more  active.  One  answer  will  be  sufficient 
for  both  these  facts.  Nature,  in  the  formation  of  ani- 
mal bodies,  has  never  made  qualities  to  oppose  each 
other.  Fat  may  have  been  very  necessary  for  the  nou- 
rishment of  those  animals  whose  wants  required  physi- 
cal alertness  ; yet  the  existence  of  fat  would  have  been 
inconsistent  with  this  last  quality.  A more  important 
function  would  hardly  have  been  made  subservient  to 
one  less  necessary.  The  fatness  of  herbivorous  animals 
is  owing  to  the  abundance  of  their  food,  not  requiring 
much  exertion  to  obtain  it.  The  herbivorous  are  fat, 
because  they  require  not  activity.  Carnivorous  are 
lean,  because  fat  would  have  been  an  incumbrance. 

Another  fact  to  be  referred  to  this  division  of  the 
subject,  is  the  fat  found  in  the  abdomen  of  horses. 
“ Equis  a concusso  per  magnos  motus  omento  adi- 
pem  non  in  venas  redire,  sed  in  abdominis  caveam 
quasi  fusum  elabi,  et  intestinis  circumfundi*.” 

It  has  been  said  before,  that  the  omentum  is  a secre- 
tory organ.  In  this  case,  the  fat  is  secreted  in  a pre- 
ternatural quantity,  to  such  a degree,  indeed,  that  the 
cells  of  the  membrane  cannot  contain  it.  Hence  they 
are  ruptured,  and  it  is  poured  into  the  abdomen.  The 
idea,  that  there  is  a greater  quantity  of  fat,  is  corroborated 
by  the  circumstance  of  its  being  altered  in  quality.  It  is 
found  “ quasi  fusum,”  which,  plainly  shows  its  secre- 
tion to  be  changed  : fat,  in  its  natural  state,  never  has 


Haller’s  Elementa  Phys.  vol.  vi,  p.  384. 


33 


that  form.  Why  violent  exercise  should  give  rise  to 
this  preternatural  secretion,  I cannot  pretend  to  say. 

Some  notice  has  before  been  taken  of  the  unequal 
quantities  of  fat  in  different  parts  of  the  body.  Collec- 
tions of  it  are  often  found  about  the  heart,  and  in  the 
extremities,  whilst  other  parts  are  much  emaciated. 
As  the  removal  of  the  fat  is  performed  by  the  absorb- 
ents, it  must  be  influenced  by  any  irregularities  that 
may  occur  in  that  system.  In  addition,  then,  to  the 
reasons  that  have  already  been  given  for  the  partial 
remains  of  fat,  I shall  observe  that  the  lymphatic,  like 
every  other  system  in  the  body,  may  be  partially  dis- 
eased. Hence  a preternatural  activity  of  one  part  will 
cause  a speedy  removal,  whilst  a torpor  in  another  will 
prevent  any  absorption  of  the  fat. 

Another  fact,  which  goes  not  so  much  to  support  the 
main  object  of  this  essay,  as  to  prove  the  nutrient  pro- 
perty of  the  fat,  and  its  use  in  the  body,  is  the  circum- 
stances of  those  persons  who  are  under  the  effects  of  fa- 
mine. Dumas,  speaking  of  long-continued  abstinence, 
says,  “It  is  worthy  of  remark,  that  the  examples  of 
this  kind  have  principally  women  for  their  object.” 
Now,  it  is  a fact  confirmed  by  anatomists,  that  fat  is 
proportionally  more  abundant  in  children  and  females. 

I have  thus  in  a cursory  manner  considered  some 
of  the  leading  points  of  this  subject.  It  has  been  more 
my  wish  to  establish  a new  opinion,  than  to  enter  mi- 
nutely into  circumstances  already  ascertained;  although, 
for  the  purpose  of  the  former,  much  of  the  latter  has 
been  necessary.  Many  facts  and  opinions  have  been 

E 


34 


omitted,  which  time  would  not  allow,  and  which  the 
occasion  of  my  writing  forbids  me  to  mention.  To 
have  considered  the  subject  in  all  its  connections  would 
have  been  to  extend  it  to  too  much  length.  The  unity 
of  nature  has  forbidden  a separation  of  different  scien- 
ces ; much  less  can  a line  be  drawn  through  those  sub- 
divisions which  have  been  designated  by  the  names  of 
particular  sciences. 

Thus  far  the  subject  has  been  considered  in  relation 
to  theory.  The  speculative  part  of  every  science  is  its 
shadow  only.  We  meet  it  first,  because  the  light  is 
placed  behind  it.  I shall  take  leave  of  it  by  consider- 
ing a few  of  the  practical  applications  of  the  subject. 

The  first  inference  that  presents  itself,  from  the  doc- 
trine I have  delivered,  is  an  argument  for  copious  and 
protracted  blood-letting.  “ In  an  adult  man,”  says  Ri- 
cherand,  “ of  moderate  rotundity,  the  adeps  constitutes  a 
twentieth  part  of  the  weight  of  the  body*.”  This,  upon 
a moderate  computation,  would  give  seven  pounds  of  fat 
for  the  supply  of  the  body ; a quantity  sufficient  for  its 
nourishment  a considerable  time.  That  it  should  not  sus- 
tain it  as  long  as  the  same  quantity  of  aliment  taken  by  the 
stomach  should  not  surprise  us,  for  some  of  the  effects 
of  famine  are  to  be  considered  as  arising,  not  from  the 
want  of  additions  to  the  body,  but  from  the  derange- 
ments which  the  system  suffers  through  the  medium 
of  the  stomach.  The  proper  state  of  this  viscus  is 
necessary  to  the  health  of  the  whole  body.  When  the 


* Ricberand’s  Physiology,  article  lxxv. 


35 


absence  of  its  natural  secretion  causes  disease  there,  no 
wonder  that  the  evil  of  famine  is  doubled.  We  should 
in  vain  attempt  to  subdue  a pulse  by  blood-letting,  if, 
at  the  same  time,  we  should  give  rich  soups  to  our  pa- 
tients, and  yet  even  a more  nutritious  substance  than 
this  the  body  is  supplied  with  by  its  fat.  Depletion,  when 
required,  may  be  continued  till  that  quantity  appears 
to  be  exhausted,  for  not  till  then  will  it  be  effectual. 
Whence,  if  not  from  the  fat,  can  be  derived  the  full 
pulse  which  attends  a chronic  fever,  when  blood  has 
been  copiously  drawn,  and  the  stomach  has  long  re- 
jected food  ? Let  not,  then,  the  fear  of  weakness  from 
venesection  or  abstinence  forbid  the  use  of  the  lancet. 

Secondly,  From  the  preceding  facts  and  reasonings, 
can  be  drawn  an  answer  to  the  common  objections  to 
fasting  in  the  cure  of  inflammatory  fevers,  or  other 
diseases  requiring  depletion.  I have  already  spoken  of 
an  advantage  to  be  derived  from  the  use  of  this  reme- 
dy in  dropsy.  The  evils  that  are  apprehended  from 
this  mode  of  treatment,  are  all  prevented  by  the  slow, 
yet  equable  supply  of  nourishment  which  the  fat  sup- 
plies to  the  body. 

A third  observation,  more  particularly  applicable  to 
the  function  of  the  liver,  is  the  case  of  a diseased  sto- 
mach, when  it  cannot  perform  its  office  in  chylopoiesis. 
That  wisdom  which  made  the  stomach,  foresaw  its  de- 
rangement ; and  it  completed  the  fabric  of  the  body,  by 
giving  fat  to  supply  the  place  of  food,  and  a liver  for 
its  conversion  into  nourishment. 


36 


* 

Lastly,  let  us  subscribe  to  the  doctrine  of  final  causes 
Aliments,  according  to  their  nutrient  power,  have  been 
divided  into  grades.  Sugar,  as  containing  the  most  nou- 
rishment under  the  least  bulk,  ranks  first  in  this  order. 
Oil  is  next  to  this  ; and  fat,  as  uniting  other  properties 
for  the  advantage  of  the  body,  was  the  most  suitable 
substance  for  its  purpose.  That  obesity  which  to  our 
eyes  may  sometimes  appear  disgusting,  is  perhaps  not 
a partial  evil,  but  a general  benefit.  The  omentum, 
which  has  been  considered  as  useless,  or  supposed  to 
perform  very  subordinate  functions  in  the  system,  ap- 
pears, from  the  foregoing  facts  and  reasonings,  to  be  a 
store  of  aliment  for  disease  and  famine. 


FINIS 


I _ 
Rush^ . 


